| Objective: Allergic rhinitis(AR)is one of the refractory diseases in the Department of Otorhinolaryngology Head and Neck Surgery.In recent years,more and more clinical researches and Randomized controlled trial(RCT)have been carried out to explore the efficacy and safety of endonasal phototherapy in the treatment of AR in adults.Through the collection and analysis of relevant documents published at home and abroad,a systematic review of the efficacy and safety of endonasal phototherapy in the treatment of AR was performed to provide evidence of evidence-based medicine(EMB)for clinical application.Methods: According to the purpose of this study,the key words and retrieval strategies are formulated.The literature on the RCT or clinical study of endonasal phototherapy in the treatment of AR was searched from PubMed,Embase,Cochrane Library,Chinese Academic Journal Full-text Database and Wanfang database,and the deadline is March 2017.According to the international PICOS(patient intervention comparison outcome study)principle,the exclusion and inclusion criteria are formulated.Based on exclusion and inclusion criteria,the related literatures were screened.The Cochrane bias risk assessment table was used to evaluate the quality of all the original literatures from seven aspects,including generation of random sequence,allocation concealment,blindness,blind evaluation of research outcome,data completeness,selective reporting and other aspects.After data was extracted from the original literature,Meta-analysis was performed using Revman5.3software.For continuous outcomes,the weighted mean difference(WMD)and its 95% confidence intervals(CI)were calculated,and forest maps and funnel plots were drew.For uncontinuous outcomes,the odds ratio(OR)and its 95%confidence intervals(CI)were calculated,and forest maps and funnel plots were drew.The efficacy included total nasal symptom scores(TNSS),Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ)and Palate itching scores,and the safety was assessed by incidence rate of severe dry and mild dry of nasal mucosa.Results: 1.The basic imformation of the selected literature.Five RCTs and 7 clinical studies were selected,and there were 615 adult patients with AR.The changes of TNSS(n=267)and RQLQ(n=213)were reported respectively in 10 and 4 studies before and after treatment.TNSS change was explored in 6 studies between the treatment(n=176)and control(n=169)group.At the same time,5 studies reported a comparison of TNSS(n=145)before and after treatment during the follow-up period.Moreover,the palate itching score(n=50)and incidence of mild dry of the nasal mucosa(n=226)were discussed respectively in 2 and 8 studies before and after treatment.The incidence of mild and severe dry of the nasal mucosa were compared in 5 studies between the treatment(n=145)and control(n=138)group.Finally,8 studies reported the incidence of severe dry nasal mucosa(n=226)before and after treatment.2.Results of Meta-analysis.For adult patientwith AR,endonasal phototherapy significantly reduced the rhinorrhea,sneezing,nasal obstruction,nasal itching,the total TNSS,emotional function,eye symptoms,nose symptoms,non-nose non-eye symptoms,activity limitation,practical problems,sleep problems,the total RQLQ and itching of the palates scores,and the difference was statistically significant(P < 0.05 for all aspects).The incidence rate of mild dry of nasal mucosa increased after treatment(P<0.05).The incidence rate of severe dry of nasal mucosa increased after treatment,but there was not statistical difference in the incidencerate of severe dry of nasal mucosa before and after treatment(P?0.05).Moreover,compared with placebo and antihistamines group,endonasal phototherapy significantly reduced the rhinorrhea,sneezing,nasal obstruction,nasal itching,the total TNSS,emotional function,eye symptoms,nose symptoms,non-nose non-eye symptoms,activity limitation,practical problems,sleep problems,the total RQLQ and itching of the palates scores(P < 0.05 for all aspects).The incidence rate of mild and severe dry of nasal mucosa increased in treatment group(P < 0.05,and P?0.05,respectively compared with control group).During the follow-up period(the time is short than one month),endonasal phototherapy significantly reduced the rhinorrhea,sneezing,nasal obstruction,nasal itching,and the total TNSS scores of adult patients with AR after treatment(P < 0.05,for each aspect).Conclusions: 1.Endonasal phototherapy can improve the symptoms including rhinorrhea,sneezing,nasal obstruction,itching of the palates and nasal itching for adult patients with AR.Moreover,it also can improve the quality of life including the inspect of the emotional function,eye symptoms,nose symptoms,non-nose non-eye symptoms,activity limitation,practical problems,and sleep problems in adult patients with AR.2.Endonasal phototherapy is safe for adult patients with AR,and can be used for patients who are not satisfied with the symptom relief.3.The total sample size is small,the high-quality literature is less,and there were lack of multicenter,double blind and randomized controlled trials.More high-quality clinical studies,RCT and large sample,multicenter,double-blind and randomized controlled trials are needed to validate the findings of this study?... |
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